Your doctor suspects cancer, don’t panic!

The news that your Doctor suspects cancer is one of the worst things that someone could imagine hearing at the doctor’s office.  It is important to understand what this means and exactly what your doctor suspects.  Multiple studies have shown that most people only remember a small amount of what is discussed with their doctor.  After a person receives bad news or what they perceive as bad news from their doctor, many people get a “clouded” mind that prevents them from receiving further information.  Some of this may be driven by preconceptions about the word cancer or by painful memories of a relative that dealt with cancer.

In medical school, doctors receive training in how to communicate in these difficult situations because you can anticipate these barriers to be present when unpleasant news is delivered.  A common strategy is to speak slowly with long pauses after sentences, to repeat information, and to ask the person being told unpleasant news to repeat what they understood from the conversation.  Even with these strategies, communicating the actual risk or concern may be difficult and the message tends to be lost a bit in translation.

Several situations arise where a doctor may tell you that he or she suspects cancer or alternatively wants to check for cancer.  Some of these include:

  • The need to screen for cancer based upon national guidelines
  • The need to screen for cancer in a different way than national guidelines based upon your individual risk factors
  • A symptom that prompts further investigation
  • A finding on examination that prompts further investigation
  • An incidental finding on “routine” blood work that causes concern and the need for further investigation

In each of these situations, the doctor is acting responsibly to not ignore a sign or symptom that might be cancer even though the actual risk of cancer may be in fact very low.  The best way to understand the reasoning is to have an open and honest discussion with your doctor to further clarify exactly what their concern is.  This may eliminate unnecessary anxiety.

Screening based upon guidelines:  Fortunately, for most common cancers there is some means to screen for them in the hopes of detecting them while they are at an early and curable stage.  Examples of screening tests include mammogram for breast cancer and colonoscopy for colon cancer.  There is no perfect test in medicine meaning the accuracy of these tests is good but never 100%.  This also means there is a chance that a cancer could be present and the test could be interpreted as normal thus missing it.  It also means that the test might indicate a cancer when in fact there is not one present.  These situations are known as false negatives and false positives, respectively.

Most screening tests are quite accurate and if they indicate a cancer require an additional confirmatory test.  The mere fact that a screening test has been ordered such as a mammogram most likely means you are being treated according to nationally established guidelines.  These guidelines have been established based upon the risk of the average person and the project cost-benefit ratio to society.  There are rare cancers that will be missed by screening guidelines, such as the unfortunate person that gets colon cancer at the age of 35.  These situations are exceptional.

Screening based upon individual risk factors:  Your doctor might indicate that you are at a higher risk for a particular cancer and the nationally established guidelines do not apply to you entirely. An example of this would be a person who has a brother who was diagnosed with colon cancer at the age of 35.  This person should not wait until 50 to get screened for colon cancer as most people should.  This person would be told by their doctor that they are at an increased risk for colon cancer and should have a test to check for its presence.  This may evoke concern but it should be more concerning if this risk was ignored and a valuable window of opportunity for cure of an early cancer is missed.  Nevertheless, an open and honest discussion with your doctor will help you understand the true purpose of the test and what your actual risk is.  This may create a sense of security rather than fear because you are helping to do what you can to prevent cancer.

An examination finding that prompts further investigation:  When during an examination there isan abnormal finding such as a lump felt in the neck it should be evaluated further with some sort of test to get more information.  Not all lumps require further testing and an experienced physician can help decide that.  There are some lumps such as those in the breast, one felt in the thyroid gland or one felt on a rectal examination that always deserve further attention.  Getting additional information should be reassuring and the purpose, possible results, and reliability of the test ordered should be discussed with your doctor.

A symptom that prompts further investigation / abnormalities on “routine” blood work:  Some symptoms are so concerning that they should prompt investigation to check for the possibility of cancer.  Doctors are trained in medical school to be alert for certain “red flag” symptoms that should not be missed.  An example of this would be the finding of a mild anemia in an older adult on yearly “routine” blood work.  This may be the only signal for the presence of a colon cancer.  Testing for blood in the stool is not always reliable and may miss roughly 25% (or more) of colon cancers.  On the other hand, the finding of anemia might be explained by many other causes such as a nutritional deficiency.  Thus, a discussion should be had in which the doctor explains the test abnormality (the test may need to be repeated – test results can vary widely between different blood draws depending on the quality of the processing center or accuracy of the collection method) and what the ensuing steps are.

REFERENCES:

  1. cancerdiagnosis.nci.nih.gov/
  2. www.cancer.gov/
  3. Curtis JR, Wenrich MD, Carline JD, et al. Understanding physicians’ skills at providing end-of-life care perspectives of patients, families, and health care workers. J Gen Intern Med 2001; 16:41.
  4. Quill TE, Arnold RM, Platt F. “I wish things were different”: expressing wishes in response to loss, futility, and unrealistic hopes. Ann Intern Med 2001; 135:551.
  5. Factors that influence cancer patients’ and relatives’ anxiety following a three-person medical consultation: impact of a communication skills training program for physicians. Lienard A – Psycho-oncology – 01-MAY-2008; 17(5): 488-96
  6. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.